Individual
JAMIE MARIA LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
500 WEST BROADWAY, MISSOULA, MT 59802
(406) 329-5615
(406) 329-2791
Mailing address
500 WEST BROADWAY, MISSOULA, MT 59802-4096
(406) 329-5615
(406) 329-2791
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
69994
MT
363AM0700X
Medical Physician Assistant
055-0031195
VT
363AS0400X
Surgical Physician Assistant
001000729
NC
363AS0400X
Surgical Physician Assistant
0670
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30207723
—
NH
05
—
9000375
—
VT
Enumeration date
12/12/2006
Last updated
05/27/2021
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